ABSTRACT To examine the outcomes of men with detrusor underactivity or acontractility undergoing holmium laser enucleation of the prostate (HoLEP).
A prospective case series between 2009 and 2012 was performed to examine short-term outcomes of men with urodynamic evidence of detrusor hypocontractility or acontractility because of a non-neurogenic etiology and concurrent benign prostatic obstruction (BPO), undergoing HoLEP.
Fourteen patients with detrusor hypocontractility and 19 patients with acontractility and evidence of BPO underwent HoLEP during the study period. Median age was 71.5 and 75 years, respectively. Preoperatively, 5 (35.7%) men with hypocontractility and 19 (100%) men with acontractility had catheter-dependent urinary retention for a median of 3 and 9 months, respectively. At a median follow-up of 24.7 months, all 5 (100%) men with hypocontractility and 18 of 19 (94.7%) men with acontractility were voiding spontaneously without the need for intermittent catheterization. Individuals with hypocontratile bladders had statistically significant improvements in American Urological Association Symptom Index (21.5 vs 3; P = .014), maximum urine flow (Qmax, 10 vs 21 mL/s; P = .001), and postvoid residual (250 vs 53 mL; P = .007) from baseline to postoperative assessments. In patients with an acontractile bladder, 15 of 19 (78.9%) displayed significant return of detrusor contractility, whereas 4 of 19 (21.1%) were voiding exclusively by Valsalva effort on follow-up urodynamic study. Postoperatively, patient satisfaction, as ascertained by American Urological Association Symptom Index, was high for both groups.
Intermediate follow-up results indicate that HoLEP is a viable management option for men with BPO and detrusor hypocontractility. Furthermore, detrusor acontractility does not appear to adversely affect postoperative results, with return of spontaneous urination and demonstration of detrusor contractility allowing for efficient voiding, in over 95% of patients.

[Show abstract][Hide abstract]ABSTRACT: To evaluate holmium laser enucleation of the prostate in patients presenting in urinary retention secondary to benign prostatic hyperplasia.
From May 2000 to May 2004, 169 patients, with a mean age of 74 years, who presented in urinary retention secondary to benign prostatic hyperplasia underwent holmium laser enucleation of the prostate. The mean urinary volume drained at catheterization was 670 mL (range 132 to 2000). All the patients were assessed preoperatively, 1, 3, 6, and 12 months postoperatively, and every year thereafter. All the patients were evaluated by physical examination, digital rectal examination, symptom evaluation using the International Prostate Symptom Score questionnaire, uroflowmetry (whenever possible), postvoid residual urine volume measurement, and prostate-specific antigen. The mean preoperative prostate volume estimated by transrectal ultrasonography was 101 cm3 (range 20 to 351).
The mean catheter time and hospital stay was 1.6 and 1.7 days, respectively. The peak urinary flow rate, postvoid residual urine volume, and International Prostate Symptom Score and quality-of-life score were significantly improved by 1 month after surgery and continued to improve during subsequent follow-up. Three patients (1.75%) were unable to void postoperatively; one required a suprapubic catheter and two used clean intermittent catheterization. Four patients (2.4%) were receiving anticoagulant therapy and required blood transfusion. Bladder neck contracture and urethral stricture developed in 1.7% and 1.2%, respectively.
Holmium laser enucleation of the prostate represents a safe and effective treatment for patients with benign prostatic hyperplasia presenting in urinary retention. It has low morbidity and provides immediate symptom and voiding improvement.

[Show abstract][Hide abstract]ABSTRACT: We report our experience with holmium laser enucleation of the prostate (HoLEP) for treatment of 552 patients with symptomatic benign prostatic hyperplasia (BPH) and their long-term outcome. Between March 1998 and January 2005, a retrospective review was conducted at our institution of 552 cases in which patients underwent HoLEP. Patient characteristics, indications for surgery, preoperative and postoperative International Prostate Symptom Score (I-PSS), peak flow rate (Qmax), postvoid residual urine, operative data, catheterization time, hospital stay, and immediate and long-term complications were recorded. The mean age of patients was 73.7 +/- 7.9 years, and the mean follow-up time was 36 months. The mean preoperative prostate size was 83.7 +/- 49.7 cm3 (range, 20 to 351 cm3), the mean enucleation time was 86 minutes (range, 15 to 255 minutes), and the mean enucleated tissue weight was 52.1 +/- 43.7 g (range, 5 to 340 g). The voiding parameters were significantly improved, with a 200% increase in Qmax, as well as a 75% improvement in I-PSS at 1 year postoperatively, which continued to improve during subsequent follow-up. A total of 11 patients required blood transfusion; 8 of them were on anticoagulant therapy. Irritative symptoms were noted in 9.4% and transient stress incontinence in 4.2% of patients. Bladder neck contracture and urethral stricture each developed in 1.3% of patients. We conclude that HoLEP is a safe and effective procedure for treatment of symptomatic BPH, regardless of prostate size, with low morbidity and short hospital stay. HoLEP appears to be the modern alternative to transurethral resection of the prostate and open prostatectomy, and it may be considered a size-independent new "gold standard."

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